In his thread Ken has had three opportunities to present the Case for Fluoridation, but he seems to be content to nibble around the edges. His stating over and over again that the fluoride ion is a natural constituent of apatites doesn’t get us very far. I was expecting by now that Ken would have tackled three basic questions head on:

1) Is it Ethical?

2) Is it Effective?

3) Is it Safe?

The ethics

I was expecting the ethical case to be tackled with rigor, but Ken quickly dismissed the central question of whether fluoridation was medical treatment as simply a matter of semantics. Clearly, if fluoridation is medical treatment or even simply human treatment, it violates the individual’s right to informed consent for such treatment. So simply declaring this to be a matter of semantics dodges a very important issue – and for many opponents of fluoridation the central issue.

So let me ask Ken if he will accept this two-part definition of a medicinal product from the European Union Directive 2004/27/EC:

Medicinal product:

(a) Any substance or combination of substances presented as having properties for treating or preventing disease in human beings; or

(b) Any substance or combination of substances which may be used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis.

No RCTs after 68 years

As for the second and third questions I was expecting Ken to layout the scientific studies that had convinced him that fluoridation was both safe and effective. Ideally, one would have wanted him to give a link to a randomized controlled trial (RCT) establishing the effectiveness and assessing the safety of this practice. This after all is the gold standard for such matters. However, after 68 years of this practice this has not been attempted.

Failing an RCT one would have wanted to see Ken identify the best quality studies that have convinced him that the practice he advocates and defends actually works to a meaningful extent against a background of other sources of fluoride, and does not present any dangers – especially to those he particularly wants to help, children from low-income families.

Moreover, since this is a practice being forced on millions of people – and in thousands of cases against their expressed opposition –one has the right to anticipate that proponents would be able produce the highest quality studies that overwhelmingly demonstrate their case. With a forced measure like this, one would have anticipated little room for any doubt about whether it worked or not, and by which mechanism it worked. Moreover, should harm be demonstrated at some higher dose level, one would have anticipated that proponents would be able show that the margin of safety would be so high that the even the most vulnerable individuals in society would be protected no matter how much water they drank and no matter how much fluoride they got from other sources.

So where is this overwhelming evidence of effectiveness and safety Ken?

Ken has ducked key discussions and questions

So far Ken has provided little evidence to demonstrate any of the above reasonable expectations for such a practice. He has even ducked key discussions on the difference between concentration (mg/liter), dose (mg/day) and dosage (mg/kg/day). Comparisons based only on concentrations – and not on dose or dosage – such as used by Siegal and Sparrow in their respective diagrams, are seriously limited if not meaningless. Nor has he addressed even the need for a margin of safety analysis when harm has been found at high doses. Ken does not deny that harm (e.g. hip fractures and lowered IQ) has been found only that the concentration (ignoring the issue of dose) was too high to be of significance

This refusal to lay out his case in comprehensive scientific terms was most clearly revealed in his response to two things I asked for in my last posting:

a) Where is the body of scientific evidence that indicates that fluoride is not a neurotoxicant?

b) Provide a list of primary studies that have most convinced him that fluoridation is safe for the bottle-fed infant and lifelong exposure for the adult.

As far as a) is concerned, I offered a large body of evidence that fluoride was a neurotoxicant:

Over 40 animal studies show that prolonged exposure to fluoride can damage the brain.

19 animal studies report that mice or rats ingesting fluoride have an impaired capacity to learn and remember.

Contrary to arguments by proponents the vast majority of these IQ studies were carried out at concentrations which offered little or no margin of safety to protect all children in a large population drinking uncontrolled amounts of fluoridated water and getting fluoride from several other sources, including sources unlikely to be available to many of the children in these studies (e.g. fluoridated toothpaste and bottle-feeding with formula made up with fluoridated tap water). Up to 10 of the studies in the Choi analysis had levels in the high fluoride village of 3 ppm or less.

So that was the weight of evidence on my side of the pan scale, it is only after seeing what Ken can put in the pan on his side of the scale that independent observers can make a scientific judgment on the true weight of evidence (see more below). Only then can we know if it is wise to ignore the many red flags being waved on this issue.

But Ken ignored this reasonable request preferring instead to rehash his criticisms of just Xiang’s work.

The need for a weight of evidence approach

What we need here – not only on neurological effects but for all the health concerns – is a weight of evidence approach. In this approach the quality, quantity, and relevance of all available evidence should be weighed and balanced (synthesized) to arrive at a conclusion. For the question of fluoridation, some of that evidence comes from animal experiments, some from epidemiological studies, some should come from RCTs on effectiveness (which amazingly -as indicated above – don’t exist for fluoride), some from medical case reports, some from basic biological/chemical/physical knowledge, and some from ethical considerations. This is what the National Research Council did in its 2006 report (except the NRC didn’t examine the ethical issues), and what we tried to do in our book and what I had hoped Ken would have attempted in presenting his Case For Fluoridation.

As far as b) is concerned, this was Ken’s reply:

Paul wants me “to list the primary studies that you have read which most convinced you that fluoridation is both safe for the bottle-fed baby and for the adult over lifelong exposure.” In thinking about this I have concluded it is a strange request because I don’t think creative scientists think that mechanically.

My concepts and ideas derive from multiple sources – I never put my eggs all in one basket as it were. I can find I am impressed by something in a paper which also has something which doesn’t impress me. Consequently I take what I can from wherever I can and try to critically understand what I read.

It’s a bit like that with people. You have to accept them warts and all and avoid the immaturity of placing anyone on a pedestal – a sure way to later find they have feet of clay.

So unfortunately I cannot satisfy Paul’s request. He will have to deal with the actual arguments I put forward.

I am sorry Ken, I don’t mean to be rude but I find this response a total waffle. If you have the science to support the safety of fluoridation – and can discount many of the health concerns that I and others have raised – then you should be able to present that case using primary health studies, and preferably primary health studies carried out in NZ. You should then be able to buttress that with all the other scientific information available and then apply a weight of evidence analysis as discussed above. After all it is a practice you want to see imposed on others; as such it is your case to win. If you can’t do that then your support of water fluoridation is highly suspect and amounts to little more than posturing. So I would like to tighten up this discussion and ask you some very specific questions.

A few very specific questions pertaining to health concerns

At the outset, before I lay out these questions, I have to acknowledge the fact that in some respects this is not a level playing field for opponents and proponents of fluoridation. It may appear that I am demanding too much from Ken. I admit that the matter is intrinsically unfair. For a critic of fluoridation it is only necessary to produce one ugly fact – one health concern that has not been resolved – to put the practice into question. I can produce several.

On the other hand a proponent of a measure that is being forced on millions of people should be on top of every health concern. A proponent should be able to demonstrate (or at least feel satisfied) that every health concern has been addressed in such a way (i.e. via careful study) so as to leave no residual concerns. It is tough burden but is the nature of the beast when proposing or supporting a health measure that is forced on millions of people.

The shocking fact is that many health questions were unresolved when fluoridation was launched in 1945 and endorsed by the US Public Health Service in 1950 (see chapters 9 and 10 in The Case Against Fluoride…).

There are many health concerns that have not been carefully studied

I am afraid that the sad truth is that there are many serious health concerns with respect to swallowing fluoride and lifelong exposure to fluoridated water and other sources in our daily lives that have simply not been carefully studied in fluoridated countries and thus still unresolved. The York Review (McDonagh et al., 2000) reached this conclusion in 2000, as did the chairman, John Doull, of the NRC (2006) review. In an interview in Scientific American (Jan, 2008), the NRC chairman was quoted as saying:

“What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long really—and now we need to take a fresh look . . .In the scientific community people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the top 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on.” (Fagin, 2008).

Doubtless Ken will point out that Doull has since made a statement supporting water fluoridation, which has been circulated by proponents. However, his own personal opinion of water fluoridation does not diminish in any way his comments on the poor quality of the research on this matter. What is even more distressing is that since the NRC (2006) report was published practically none of the research recommended by the committee has been carried out.

Ken will find out for himself how poorly fluoridated countries – especially New Zealand – have investigated the health concerns pertaining to fluoridation, if he opens his parachute and seeks answers to the very specific questions I have listed below.

My specific questions for Ken pertaining to health concerns

1) Can you find studies that have convinced you that lifelong exposure to fluoridated water and other daily sources of fluoride (i.e. total daily dose of fluoride) is not increasing the risk of arthritis or arthritic-like symptoms, which have been identified as being the first symptoms of fluoride toxicity in research on skeletal fluorosis (see, e.g., Boillat 1980; Czerwinski 1988; Hileman 1988). These symptoms occur long before we reach bone levels that cause crippling skeletal fluorosis, the only end point considered by the US EPA when they determined the safe drinking water standard for fluoride in 1986 (i.e. 4 ppm).

2) Repeating two earlier requests, can you produce the studies that have convinced you that long term exposure to fluoridated water and other common sources of fluoride causes no damage to individuals with impaired kidney function?

3) Can you find studies that have convinced you that exposure to fluoridated water and other daily sources of fluoride (i.e. total daily dose of fluoride) is not increasing the risk of lowered thyroid function, including among those with suboptimal iodine intake (Galleti and Joyet, 1958; Lin 1991). This is an especially relevant question in light of the increase in iodine deficiency seen in the U.S. and other western nations over the past 30 years, as well as the large increases in the incidence of hypothyroidism. Lowered thyroid function would be one explanation for lowered IQ and would also explain the delayed eruption of the teeth for which there is some evidence.

4) Can you find any study that has refuted the key finding by Bassin et al., 2006, that there appears to be an age-specific nature to the risk of boys developing osteosarcoma when exposed to fluoride? In a matched case-control study Bassin found that boys exposed to fluoridated water in their 6th to 8th years had a 5-7 fold increased risk of succumbing to osteosarcoma by the age of 20. Note: The much-anticipated study by Bassin’s thesis advisor Chester Douglass (Kim et al, 2011) failed to address Bassin’s central thesis concerning the age-specific nature of the risk despite prior claims that it would (Joshipura and Douglass, 2006)

5) Can you find any attempt by any health agency in any fluoridated country to investigate in a scientific manner a) the many anecdotal reports, b) case studies by Waldbott, 1955; Shea et al., 1967; Grimbergen, 1974; Petraborg, 1974, 1977; and c) a clinical trial by Feltman, 1956 and Feltman and Kosel, 1961, that suggestthat some individuals (may be 1% of the population) are very sensitive to low levels of fluoride exposure (e.g. 1 mg per day)? These individuals report experiencing a variety of symptoms that are reversed when the source of fluoride is removed and reappear when the fluoride is introduced. Please note: The Australian National Health and Medical Research Council recommended such scientific studies be carried out in 1991 (NHMRC, 1991), but not one has been carried out in the 22 years since this recommendation was made. See more discussion on this topic in chapter 13 of our book and in Spittle (2008).

6) Can you find any attempt by any health agency in any fluoridated country to follow up the finding by Schlesinger et al, 1956 in the Newburg-Kingston, NY fluoridation trial, that the young girls in the fluoridated community were menstruating on average 5 months earlier than the young girls in the non-fluoridated community?

7) Repeating an earlier request discussed above, can you provide a list of animal and human studies that nullify the weight of evidence I have listed above that indicate that fluoride is a neurotoxicant with an inadequate margin of safety to protect all children (including those with nutrient deficiencies) drinking uncontrolled amounts of fluoridated water in addition to fluoride ingested from other sources?

8) Can you point to any studies conducted in fluoridated countries that have convinced you that exposing babies to fluoridated water causes no other damage to their developing tissues other than the damage to their growing tooth cells leading to dental fluorosis? Or is this just wishful thinking on the part of proponents? Is it likely that the fluoride ion would confine its biochemical interference only to the growing tooth cells? What about bone cells? Brain cells? Thyroid gland cells?

9) Can you find any study carried out in NZ or any other fluoridated country that has set out to assess total exposure to fluoride by monitoring fluoride levels in bones at either biopsy during operations or at autopsy? Note: this was another suggestion made by the Australian NHMRC in 1991 but was never pursued by any Australian health agency.

10) What studies carried out in NZ have investigated any health concerns in fluoridated communities? I couldn’t find many can you? Would you agree that the absence of study is not the same as absence of harm?

The evidence of fluoridation’s effectiveness is weak

Similarly, we need to tighten up the discussion of fluoridation’s effectiveness. A scientific proponent like Ken should be able to present the primary scientific studies and weight of evidence analysis that has convinced him that drinking fluoridated water leads to a significant reduction in tooth decay. Being able to offer a theoretical mechanism of action (and I discuss some of Ken’s ideas on this below) is only part of the requirement.

In chapters 6-8 of our book we present the case that the evidence that swallowing fluoride or drinking fluoridated water reduces tooth decay by a significant amount – is very weak – especially in the permanent teeth. This is especially apparent in the larger studies like the US National Institute of Dental Research (NIDR) study reported by Brunelle and Carlos in 1990 (this incidentally was the largest survey of tooth decay ever carried out in the US). The authors looked at 39,000 children in 84 communities and reported an average saving in tooth decay for 5 to 17-year-olds of just 0.6 of one permanent tooth surface (see Table 6). This meager saving of 0.6 of one tooth surface out of over 100 permanent tooth surfaces in a child’s mouth was not even shown by the authors to be statistically significant. I think for most people such a benefit – even if it was real – would be of an insufficient magnitude to justify forcing the practice on people or taking the many health risks involved, especially the possibility that we may be lowering the IQ of some of our children.

To these studies we must add in a weight of evidence approach two other facts: 1) several modern studies have not found tooth decay to increase when fluoridation has been stopped in various communities in Finland, former East Germany, Cuba and British Columbia, Canada and 2) the many press reports from major cities in the US of a dental crisis in low-income areas even though they have been fluoridated for over 20 years (for citations see Chapter 8 in The Case Against Fluoride…).

Again what we are looking for here is a presentation of the evidence by Ken that would persuade an independent observer that the weight of evidence for effectiveness is very strong and outweighs the evidence of little benefit presented in the studies cited above.

Ken’s topical mechanism via saliva and plaque

As with other proponents of fluoridation, Ken asserts that fluoridated water works topically, by increasing the level of fluoride in saliva and plaque. There is scarce data, however, to support this claim. Ken cites four papers (only one of which is a primary study), but as I discuss below, these papers do little to answer the key questions: namely: (1) are the saliva and plaque F levels produced by fluoridation high enough and of sufficient duration to prevent caries, and, if so, (2) are the differences in saliva and plaque F levels between children in fluoridated and non-fluoridated communities of sufficient magnitude to produce a meaningful difference in caries?

There is scarce data in the four papers Ken cites (Cury & Tenuta 2008, Martínez-Mier 2012; Featherstone 1999, Bruun & Thylstrup 1984). Of the papers, only Bruun & Thylstrup 1984 is an actual study, and it deals with a high-fluoride community (2.31 ppm), and thus, were it a study on adverse health effects, I suspect Ken might claim it irrelevant to fluoridation. But, assuming it is relevant, it’s worth noting that – although the authors found a lower caries rate in the high-F community (vs a community with 0.36 ppm) — the authors note that their “analyses relating the individual fluoride concentrations in whole saliva to the clinical caries scores within each of the two areas indicated that no causal relationships seem to exist between these two parameters.” So, while the authors conclude that “frequently increased availability of fluoride in the oral fluids due to [waterborne fluoride] has an important relationship to the reduced caries experience observed in the high F area,” their conclusion can be questioned, particularly as it relates to the 0.7 ppm water F level used in fluoridated communities.

So, what is the evidence that the saliva and plaque levels produced by fluoridated water exerts a significant topical benefit? According to the reviews that Ken cites (and the notably few studies that these reviews reference), the average saliva F level among children in a community with 1.2 ppm fluoride is 16.5 ppb with daily fluctuations that range as high as 144 ppb (Oliveby 1990, cited by Cury). To put these saliva levels in context, Featherstone states that 30 ppb is the lowest level at which fluoride has been observed to have an effect on tooth mineralization, with >80 ppb being the “optimum” (Featherstone 1999). Featherstone supports this statement by citing a single study – Brown (1977). Assuming that Brown’s study can be replicated, it is evident that the average saliva F level in a 1.2 ppm community — let alone a 0.7 ppm community — is not sufficient to affect tooth mineralization. Any topical effect of fluoridated water, therefore, must either come from the transient spikes in saliva F or the residual F in plaque. Judging by the papers Ken cites, the evidence supporting either of these scenarios is meager at best.

I’ll start first with the transient spikes in saliva F. While spikes in saliva F in fluoridated areas can exceed the levels (30 to 80 ppb) that Featherstone claims can affect teeth, this does not tell us a great deal. To be relevant, it must be shown that the transient spikes are not only high enough, but long enough, to have an effect. Neither Featherstone, nor any of the other papers cited by Ken provides data to answer this question. Further, even if the transient spikes are of sufficient duration to have an effect, it must be asked whether this effect is of any practical import in the current era when the vast majority of children in non-fluoridated areas brush their teeth with fluoride toothpaste? The importance of this latter question is obvious in light of Featherstone’s observation that “fluoride can be retained at concentrations in the saliva between 0.03 and 0.1 ppm for 2-6 hours” after the use of fluoridated dental products.

I’ll now turn to the question of plaque fluoride. Only one of the papers cited by Ken appears to provide any data on the difference in plaque F levels between fluoridated and non-fluoridated communities (Cury & Tenuta 2008). The plaque F data that Cury & Tenuta cite is not only unpublished, but is at rather stark odds with previously published data (See Whitford 2005). Cury & Tenuta claim “an almost 20-fold difference” in plaque F levels (3.2 ppm vs. 0.2 ppm). Whitford, however, found far higher F levels in the plaque (~50 to 450 ppm) and a far smaller difference (2-to-5 fold) between the fluoridated and non-fluoridated community. But Whitford’s study was itself quite peculiar as the unfluoridated community was in Brazil, but the fluoridated community was in the U.S. If children in the U.S. community had greater exposure to fluoride from other sources (which is not only possible, but likely), then the difference in plaque F levels is even smaller than Whitford’s study suggests.

In any event, whatever the difference in plaque F levels is, we should have ample data showing that this differential is sufficiently large to produce a significant and practical effect. I am unaware of any such study, so I will be quite curious to see how many Ken can cite. This shouldn’t, of course, be a difficult task: if plaque F is considered the main vehicle by which fluoridated water exerts a topical benefit, there should be no shortage of primary studies that Ken can cite demonstrating that the plaque F seen in fluoridated areas [x plaque F level] is far superior to the plaque F level seen in non-fluoridated areas [y plaque F level]. I look forward, therefore, to seeing the studies that Ken cites — particularly when considering that Buzalaf found that toothpastes containing 500 ppm fluoride are not effective at controlling caries (Buzalaf 2013). By way of reference 500 ppm is more than twice the background plaque F levels seen in fluoridated areas according to Whitford, 2005.

Brunelle JA and J. P. Carlos (1990). “Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation,” Journal of Dental Research 69: 723–27.

Bruun C, Thylstrup A. (1984). Fluoride in whole saliva and dental caries experience in areas with high or low concentrations of fluoride in the drinking water. Caries Res. 18(5):450-6.

Buzalaf MA, et al. (2013). Low-fluoride Toothpastes May Not Lead to Dental Fluorosis But May Not Control Caries Development. Standard Fluoride Toothpastes Can Control Caries Development But May Lead to Dental Fluorosis. J Evid Based Dent Pract. 13(4):148-50.

Locker, D (1999). Benefits and Risks of Water Fluoridation: An Update of the 1996 Federal-Provincial Sub-committee Report, prepared under contract for Public Health Branch, Ontario Ministry of Health First Nations and Inuit Health Branch, Health Canada (Ottawa: Ontario Ministry of Health and Long Term Care, 1999.

53 responses to “Fluoridation debate: Against Fluoridation Thread. Part 6.”

Paul’s personal opinion that fluoride is a “drug” has been duly noted, and is getting tiresome. Courts have repeatedly ruled contrary to this opinion and he needs to get past it. It’s going nowhere, no matter how many times he attempts it.

Steve what type of additive is NaF???? (adding to water makes it an additive ie its not there naturally in the form added)
If it’s not a drug (though I’m not sure what the court said as the link provided previously (BY OTHERS) didnot work and the claim, was pages long, & I would have thrown the claim out for lack of clarity, but I’m not a Judge/Lawyer, remember lawyers only get it right 50% of the time, I do think Judges get it right a little more often)
it’s not a toxin
So please explain what you would call such a substance.
My definitions have been distorted after reading the pro & con I would like you to define what sort of additive it is

Courts have repeatedly ruled contrary
There has only been one link to a court which ruled against F (no workable link for the decision) Can you give links of such decisions and what the original claim was so can see exactly what the court decided & why

“So please explain what you would call such a substance.”
Personally I call it a beneficial trace element. I wouldn’t call my milk with extra added calcium a drug. I’m not going to call my water with extra added fluoride a drug.

I’m not the one who brought up NaF. You’ll need to get whatever they meant, from whomever brought it up in the first place. I simply stated that fluoride ions released by it are identical to those from CaF and HFA. HFA, however, is nothing more than a substance that delivers fluoride ions to water for the purpose of raising the existing level of fluoride up to the optimal level. Fluoride ions and trace contaminants in concentrations too miniscule to have any effect, are the only products of the hydrolysis of HFA. HFA no longer exists once hydrolyzed.

When Connett and other antifluoridationists persist in attempts to term fluoride at 0.7 ppm a “drug” they are actually claiming that a miniscule amount of fluoride ions identical to those fluoride ions which already exist in water, is a drug. That is ridiculous.

Steve
Chemistry F ions are identical once released are identical but not before… availability of F from Na monovalent cation is much higher than that from Ca a divalent cation. If its not why not add “natural Flouride”
Thats not the point the point is that in the form added Sodium HFA what do call it?, how you call the additive alters who is responsible
Please provide links to your court cases affidavits from claimants and Judges ruling so we can see exactly what the courts said and what was claimed

A decision based on relevant legislation state versus city at law ..if one wanted such a change the original legislation would need to be attacked which would very difficult until the ultimate studies are done where harm with be proved or disproved ie where additive is tested appropriately in a completely controlled environment we all know the cost in this
It was interesting that the California Dental Association Foundation was funding the fluoridation process

I have no idea as to what Na HFA may be. If you mean hydrofluorosilic acid (HFA), again, that is nothing more than a vehicle to deliver additional fluoride ions to water systems with a fluoride content less than 0.7 ppm. Once hydrolyzed, HFA no longer exists in that water.

I also have no idea as to what problem you have in understanding definitions, but fluoride is nothing more than the anion of the element fluorine. It exists “naturally” in water as released by CaF.

I have re-posted this comment (altered slightly for clarity) on this thread as it is more relevant to Connet’s reply to Ken Perrott’s last article Fluoridation debate: Why I support fluoridation – 2nd reply to Connett.

Hi Bill, and (ANY other anti- fluoridationist)

I would appreciate your take on this and ANY other anti- fluoridationist

This is directly applicable to Connet’s recent 4th question.

“Can you find any study that has refuted the key finding by Bassin et al., 2006, that there appears to be an age-specific nature to the risk of boys developing osteosarcoma when exposed to fluoride?…”

Well, what about this study….

“Fluoride in drinking water and osteosarcoma incidence rates in the continental United States among children and adolescents”

Paul Connett really gave a “Gish gallop” performance on this post. A look at his references at the end are very telling:

His reference for an article by jj Shea , “allergy to fluoride in the Annals of Allergy 1967 doesn’t exist on PubMed. He, once again, gave 3 glowing references to his book (sales must be lagging), 9 references to the rag journal, Fluoride, which, also, you won’t find indexed on PubMed. One of articles was by the late John Yiamouyiannis, a well-known anti-fluoronista who wrote a book that HIV did not cause aids. He also refused conventional treatment for colon cancer and ran off to Mexico to treat his cancer with laetrile and vitamin C, Guess what? He died at age 58. There were also 10 references to the late John Colquhoun, who our Kiwi audience here knows is a joke, and one reference to Bill Osmunson from my home state of Oregon in the U.S. who has had articles of his “home made” graphs in his attempts to prove that fluoridation: 1)doesn’t reduce cavities; and 2) causes mental retardation. Bill can get his bogus graphs written up in Fluoride, but so far, my suggestion to him that he get his rubbish published in a legitimate scientific journal that is indexed on PubMed has fallen on either deaf ears or he knows that it truly is rubbish.

Maybe when Paul writes another bible, uh book, on fluoride, he can include Bill’s graphs.

When Brunelle and Carlos’ study came out in 1990, they used the more sensitive DMFTS, NOT DMFT like Dr. Yiamiouyiannis, who manipulated the data, to confuse the general public.

The FAN interpretation also ignores the most important part of the study, that being the Halo Effect of fluoridation. In the Pacific Region VII, where at the time, only 20% of the public water systems were fluoridated, the DMFTS was 61%, a significant statistical difference.

Lastly, Paul’s apparent ignorance of the eruption patterns ignores that Brunelle and Carlos were only measuring tooth surfaces in adult/permanent teeth, beginning at age 5. Guess what? There are virtually no permanent tooth surfaces to measure at age 5. When teeth erupt, beginning primarily at age 6, they don’t typically decay overnight, but it takes 2,3, maybe 4 years to see cavities. Even at age 9, there will likely be between 52 and 60 permanent tooth surfaces, not over 100 surfaces as Paul states.

You should read the Letter that Howard Pollick wrote to. Paul Connett, on the Brunelle and Carlos study and take a good look at figure 1 which shows that the number of saved surfaces in a fluoridated community increases from age 5 to 17:

Kurt Ferre, The overall 18% difference in decayed, missing and filled teeth (in 5 to 17 year old) reported by Brunelle & Carlos amounted to an overall average difference of 0.6 of one tooth surface in the average mouth. A full set of permanent teeth has 128 tooth surfaces. Why are you too eager to inflict a medical treatment on others without their informed consent?

Not a scientific study, a journal article, or even an op-ed written by a scientist…

Are you serious? A 15yr old newspaper article written by a journalist!!
A journalist who has written articles questioning climate change no less!!”

So, again were you serious?

And how low does the bar need to be before YOU accept information as “fact”
The logical corollary of all this is…Why can’t mainstream scientist’s vault over this so incredibly low bar with the ease of a horny gazelle?

Am I missing something here blossom 18% of 128 is not .6 I know it sounds more impressive to quote tooth surface but how do you know how many teeth the subjects had to start with. It sounds a bit alice in wonderland to me

I hope I am not opening up a can of worms but…
Here’s an open question to FANNZ (I’m pretty sure they’re watching) or perhaps Ken,
Ken’s blog has been running for some time now. I have learnt a great deal from Ken and the many contributors. For that, I thank Ken wholeheartedly.
But…
We get Paul Connet’s views, but there is no second tier to tidy up/clarify his or the FAN/FANNZ position.
I assume FANNZ is a paid up card carrying fan boy of FAN?
There have been many individuals voicing their concerns about fluoride but I would be interested as to why there been no representative from FANNZ giving their “official” perspective or availing himself/herself for comment?

Blossom,
I can only assume that you get your filtered information from either FAN or FANNZ websites.
I suggest that you go to the American Dental Association or the New Zealand Dental Association and search for “Halo Effect”.
Second, at the age of 9 or 10 years of age, a child does NOT have a full complement of teeth. Thus, the 128 surfaces that you reference are not present. There are still many deciduous or baby teeth in the mouth, and the tooth surfaces on these teeth do NOT count. It is only the surfaces of permanent teeth that are counted. I stand by my 52 to 60 tooth surfaces in permanent teeth at age 9.
BTW: Did your parents name you Blossom?

I have replied to Ken on facebook that there is no directive, nor can I imagine anyone feels intimidated by anyone here. For myself I haven’t commented much because I don’t have enough time and I can’t really see much point. I think that is probably the same for others.

The argument just goes on and on and we don’t understand why you people are so intent on forcing this on others. Regardless or whether it is actually a drug or whether it is safe or effective we believe the water supply is a shared commodity and everyone, poor or not, educated or not, has a right to chose what substances they take. I find the proclamation that this is being done for poor children whose parents do not make them brush their teeth, to be offensive. However, obviously you guys don’t see it that way – but this is so fundamental that I can’t see how we can ever agree. It wouldn’t matter if you had me believe that fluoride was some kind of amazing substance that had a huge amount of health benefits and no harm I would still be opposed if there were other people did not want it.

I will make one comment about the osteosarcoma study cited above. What Paul asked for was a study that showed age-related exposure. That 2011 study doesn’t show that., The only one that does is Bassin. That is the missing link in the fluoirde-osteosarcoma puzzle.

However, obviously you guys don’t see it that way – but this is so fundamental that I can’t see how we can ever agree.

Speaking for myself, I respect the your argument over choice. That is a political and social policy debate.

However I suspect most regular readers here, certainly myself, take far greater interest in the dishonest presentation of science and logically fallacious, even absurd, arguments often presented by the anti fluoridation lobbyists. Remove that and perhaps we have room to talk.

As to your being offended, well, shrug. There is altogether too much offence going around these days. Giving in to offence opens the door to the curtailment of free speech.

Regardless or whether it is actually a drug or whether it is safe or effective we believe the water supply is a shared commodity and everyone, poor or not, educated or not, has a right to chose what substances they take.

(groan)

Chlorine. Hello?

I find the proclamation that this is being done for poor children whose parents do not make them brush their teeth, to be offensive.

Why would you be offended at helping poor children? It’s a public health measure. Fluoridating water helps the community (you, me, everybody). It’s incredibly cost-effective. Less cavities are good for everyone, not just for those that don’t have to go to the dentist as often.

The scientific community is not lying to you.
There is no spooky-wooky global conspiracy.
There’s a reason why when you go shopping for support for your ideas, you are restricted to no-name blogs.
The rest of us can just go straight to the top. We don’t need the blogs or the vanity-press books of the conspiracy peddlers.

It wouldn’t matter if you had me believe that fluoride was some kind of amazing substance that had a huge amount of health benefits and no harm I would still be opposed if there were other people did not want it.

Smallpox. Not just a pretty work.
Let’s test this mentality of yours, shall we?
We shall.

“It wouldn’t matter if you had me believe that the smallpox vaccine was some kind of amazing substance that had a huge amount of health benefits and no harm I would still be opposed if there were other people did not want it.”

Mary states, “I find the proclamation that this is being done for poor children whose parents do not make them brush their teeth, to be offensive.”

As a dentist for nearly 38 years, I would like to share a different perspective to Mary’s above quote. I can be judgmental as the next person, and I see every day in my daily tasks adults who have made “bad choices”.

My very first day doing volunteer work several years ago, a 9 year old boy presented to me with a painful, swollen, abscessed upper 6-year permanent molar tooth. He didn’t have dental insurance as children in New Zealand have. My first question to him was, “How long has this tooth been hurting you?”. His response, “I can’t remember”. This tooth was non-restorable, and I had to pull it. This young boy was extremely brave and stoic.
On my drive home that afternoon, I reflected that this wasn’t: 1) the typical patient that I saw in my practice; 2) this young boy didn’t choose who his parents are; and 3) my own two daughters, whose mother in a pediatrician and father a dentist, would NEVER, EVER have to experience this kind of dental pain.
This began my transformation in understanding that public health is about treating a population, not an individual. Ken has mentioned in his earlier blog about “freedom of choice”. I agree that it is important. But I’ll end it with a quote that has given me a perspective that differs from yours:

“We should ask not are we entitled to impose fluoridation on unwilling people, but are the unwilling people entitled to impose the risks, damage & costs of the failure to fluoridate on the community at large? When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”

Dr. John Harris, Dept. of Social Ethics and Policy
University of Manchester, UK

Steve. the big difference here is we probably have less people in the whole country than you do in one suburb.In saying that we are more aware of what is going on in our “suburb”, and anything out of the ordinary gets noticed. The recent debacle in Hamilton, and the one going sideshow in South Tananaki is in the press, so people ask questions and talk about it. We have not got a big population base with heaps going on and your state level stuff would be equal to our total news, things dont get buried in the flood of press statements

When you scroll down to table 6 on page 5 in Brunelle and Carlos paper and calculate for all ages the absolute difference between lifelong water fluoridation exposure and no water fluoridation exposure (3.39 – 2.79), you get .6 (mean DMFS). This .6 is out of 128 DMFS and can further be calculated to represent a percent. In its percent form it’s .5 percent that is half a percent! This is how most people understand and look at differences. John has 10 apples and Alex has 5 apples, what’s the difference? Ten minus five equals five apples. It’s that simple. Now Brunelle and Carlos calculated the data using a different method called relative difference. They took the first number, subtracted the second number, then divided the answer by the second number and rounded to the nearest hundredth to get a dramatically more impressive number. (2.79 – 3.39) / (3.39) = -.1769 or when rounded, dropping the negative sign and reflected as a percent, they came up with 18 percent. Therein lays the deception. It’s funny how Brunelle and Carlos make no mention in their table of using relative difference to calculate the data. Relative difference has been misused to misrepresent and exaggerate the numbers. Regarding their claim of a further reduction of 25% when removing participants who were exposed to fluoride by other means than water fluoridation; what about the halo effect? Beverage and food are made with fluoridated water. Where do you find children that have never been exposed to fluorides other than from water fluoridation? None of these kids brushed their teeth ever, with fluoridated toothpaste? “In an attempt to assess more clearly the effect of water fluoridation, children with a reported history of exposure to supplemental or topical fluorides were removed from the analysis.” Operative words here are “in an attempt.” Their own language here tells me that they could not conclusively rule out children who were fluoridated by other means. What are the numbers they use to support their conclusion of a 25% reduction? Where is the table for this data? I don’t doubt that they probably used the same method of relative difference to calculate this number as well. Dr. Yiamouyiannis paper is definitely worth a look as he comes up with completely different conclusions and points out serious errors made by Brunelle and Carlos. Health policies like the mouth rinse programs in the United States were supported by this grossly exaggerated and misleading white paper which has to make you wonder what other policies either here in Canada or elsewhere have been influenced as well.

Myles26 Thanks for that.
It makes sense if you want to enhance the data. I looked at the B+C paper before and though ok I cant see how this works, but did no know of the “relative diffrence” model. I would have thought Connetts crew would have jumped on this like flys on a turd, to make their numbers look better
Sorry Blossom you were right

Dr. Yiamouyiannis paper is definitely worth a look as he comes up with completely different conclusions and points out serious errors made by Brunelle and Carlos.

Is this the same Dr Yiamouyiannis?

“John Yiamouyiannis, Ph.D. (1945-2000) was the most prominent opponent of water fluoridation in the United States until his death in 2000. He is the author of the book Fluoride, the Aging Factor, the pamphlet A Lifesaver’s Guide to Fluoridation, as well as the co-author (with Peter Duesberg) of AIDS: The Good News Is HIV Doesn’t Cause It.

He was best known for being the “go-to” person for those trying to stop fluoridation in their communities. Originally he had been the biochemical editor at Chemical Abstracts Service, where he became convinced fluoridation was dangerous. He was the “science director” of the National Health Federation (an anti-fluoride, pro-quackery advocacy group) from 1974 to 1980, who hired him to “break the back of promoters’ efforts to fluoridate more American cities.” His pamphlet “A Lifesaver’s Guide to Fluoridation” was usually distributed by opponents anywhere where fluoride was being considered, and Yiamouyiannis was often called to testify before local city councils and county boards in opposition. In 1980 he left the National Health Federation to start his own anti-fluoridation advocacy group, the National Health Action Committee. His claims – fluoride causes cancer, speeds up the aging process, causes bone deterioration, etc. have been disproven (at least in the low levels in municipal water supplies) by many scientific studies yet he persisted in them. In the early 1990s he found another angle to use, an environmentalist one: fluoridation was a plot by industries such as ALCOA to dispose of their toxic waste by putting it in our drinking water.

He also ran for President in 1992 as an independent but was only on the ballot in a few states. He died of colorectal cancer in 2000, which he chose to have treated in several Mexican clinics with laetrile and vitamins instead of seeking conventional treatment. Colorectal cancer has a 95% chance of survival beyond 5 years if caught early and properly treated using scientifically proven methods.

Since his death the anti-fluoridation movement has passed on to others and his work and name have become much less prominent – to the point that Wikipedia does not (yet) even have an article about him.”(link)

Cedric, play the ball not the man. Dr Yiamouyiannis gained access to Brunelle and Carlos hard data through a Freedom of Information Act request and Yiamouyiannis’ critique of the paper can be found here for anybody who is actually interested in getting underneath the hood: http://www.slweb.org/nidr-dmfts

Does the fact that Yiamouyiannis was a certifiable crank that denied the science of HIV and AIDS slow you down a little in using him as a source of information?
Just a little?
How much scraping of barrels are you prepared to do to find somebody (anybody!) to help prop up your preconceptions?

Minimum standards: Not just a pretty phrase.

I don’t care about him as a person. Wouldn’t bother me at all if he was all sorts of nasty things. He could have been a Nazi, a kitten molester and one of those people that clip their toe nails in expensive restaurants for all I care.
Doesn’t matter.

However, his grasp of scientific reality was abysmal.
It killed him in the end.
He aided and abetted a monster like Duesburg who helped kill thousands of Africans who would otherwise have received help and real medical support from their government.
Yet this is your standard. How did you sink so low?

There’s a reason why I always compare and contrast one science denier group with another. It’s the same path. You don’t have to do anything different. The same methodology that will allow you to deny the scientific consensus on flouride will allow you to deny the link between HIV and AIDS.
Science denialism is dangerous.

Consequences of AIDS denialism

In 2000, Duesberg was the most prominent AIDS denialist to sit on a 44-member Presidential Advisory Panel on HIV and AIDS convened by then-President Thabo Mbeki of South Africa. The panel was scheduled to meet concurrently with the 2000 International AIDS Conference in Durban and to convey the impression that Mbeki’s doubts about HIV/AIDS science were valid and actively discussed in the scientific community. The views of the denialists on the panel, aired during the AIDS conference, received renewed attention. Mbeki later suffered substantial political fallout for his support for AIDS denialism and for opposing the treatment of pregnant HIV-positive South African women with antiretroviral medication. Mbeki partly attenuated his ties with denialists in 2002, asking them to stop associating their names with his. In response to the inclusion of AIDS denialists on Mbeki’s panel, the Durban Declaration was drafted and signed by over 5,000 scientists and physicians, describing the evidence that HIV causes AIDS as “clear-cut, exhaustive and unambiguous.”

Two independent studies have concluded that the public health policies of Thabo Mbeki’s government, shaped in part by Duesberg’s writings and advice, were responsible for over 330,000 excess AIDS deaths and many preventable infections, including those of infants.

I go with that too. I stumbled into Ken’s blog three years ago in pursuit of a AGW denier, read one of Cedric’s demolitions and thought that this is the place for me.

When witnessing the unsuspecting visitor engage with the maestro I’m always reminded of a couple of passages from TH White’s The Once and Future King, in it Lancelot demonstrates why he enjoys the reputation he has. It’s almost comic knowing what is coming. I might even post a passage some time if Ken doesn’t mind the diversion.

I find it interesting that Dr John Colloqhoun is written off as an anti-fluoridationist, with no credibility etc. I assume you have the same opinion of Hardy Limeback, Andrew Harms etc. Fact of the matter is these people were totally for fluoride, in fact they promoted it. In each country that fluoridates its water one of the main promotors at some stage in their life turns around and speaks ill of it. They only became anti-fluoridation after they had been subject to political “treatment’ . These folk were not antifluoridationists waiting for their break as you might fantasise about, what about the massive numbers of american scientists who signed the epa Union petition, they were not originally anti-f. They only chose to take a side in the matter after politics played a greater role than science. why have so many scientists who had something to do with a fluoridation study, become nutters.? Should you not be more curious as to why this occurred ? Or are you just so married to an irresolvable argument that you discredit people, even after their death.

Fact of the matter is these people were totally for fluoride, in fact they promoted it.

So? What has that to do with anything?
Take Kaysing, for example.

Fact of the matter is, Kaysing was totally for the Moon Landings, in fact he worked for NASA. etc. etc.

They only became anti-fluoridation after they had been subject to political “treatment’.

So how does the conspiracy work?
Is it anything like the vaccine conspiracy?
Or the evolution conspiracy?
Or the climate change conspiracy?
Political “treatment”.
Hmm. I wonder what that could possibly mean? It’s a pity you only give tantalizing hints.

why have so many scientists who had something to do with a fluoridation study, become nutters.? Should you not be more curious as to why this occurred ?

Does that work for Wakefield too? How about Deusberg? Shall we apply that to Behe as well? You don’t have to restrict this kind of thinking to just fluoride, you know. Oh no. There’s lots and lots of topics out there where the scientific trooth is being bravely championed by maveriks blah, blah, blah, who have decided to challenge the scientific dogma blah, blah, blah.

Or are you just so married to an irresolvable argument that you discredit people, even after their death.

How curious.
Somebody joins forces with the likes of Deusberg and this doesn’t discredit them?
That same person dies a premature death because they embraced medical quackery but..that doesn’t discredit them.
What would someone have to do in order to discredit themselves?
The mind boggles.

what about the massive numbers of american scientists who signed the epa Union petition…

Wait. I’ve got it!
JJ means that once a person dies, their scientific opinion becomes more valid and worthy of respect…because they’re dead…and it wouldn’t be nice to poke holes in a dead person’s “science”. They become sort of holy or something. Take Einstien, for example. He’s dead and and so nobody would dare criticise the Theory of Relativity.

(….awkward silence…)

I don’t think JJ has a firm grip on this science thingy and how it works.
It’s almost as if they’re mixing it up with religion or something.

Cedric is definitely my daily entertainment, but all you guys are knowledgeable, well informed, and well on top of this issue. In The U.S., antifluoridationists seek to get the question out to a public vote because they know they can easily sway them with an onslaught of fear-mongering misinformation, ala Portland. NZ seems to be the opposite. It’s much smaller, but even so, your general public seems far more informed, probably because of guys like Ken, you, Cedric, Stuart, Chris, and others who understand the issue, know how to effectively communicate, and can quickly cut through the BS right down to the the core..

You are assuming that all of those who say they were originally for fluoridation were actually for it. This is doubtful. Some may have changed their thinking, but, in all likelihood, the vast majority who claim to have been for fluoridation at one time before switching, are either deluding themselves into believing this, were completely neutral, never having given it much thought, or are simply being dishonest with this claim. The vast majority of fluoridation opponents do not object to it on the basis of science. They object on the basis of personal ideology against what they view as “government intervention” and/or a violation of their “personal rights”. They cloak this in pseudoscience because they understand that their personal ideologies will not carry the day without some semblance of science to supposedly support their position. This is clearly evidenced by the fact that no matter how much valid science is presented to them, as long as it disagrees with their personal ideology, which it always does, they will reject it. It is also evidenced by the fact that with all the horrifying “disorders” they claim caused by fluoridated water, they still drink it. No one in their right mind who actually believed those claims would get within a mile of such water, much less drink it on a regular basis. Personal ideologies do not change overnight., thus it is highly likely that the majority of those who claim to have once supported fluoridation, in actuality did not.

As far as the “massive” numbers of American scientists who “signed a petition”, you are assuming that most, or all, of the EPA scientists were members of the union led by staunch antifluoridationist William Hirzy, and that they were all on board with his petition. In actuality, this union was a very small one representing only a couple thousand workers in an agency composed of tens of thousands. It only took a small handful of these members, probably an Executive Committee, to commit the entire union into supporting Hirzy’s antifluoridationist activities. Shortly after this action was accomplished, this union went defunct and was absorbed by a much larger one which, to my knowledge, has not expressed an official opinion on fluoridation. As a point of information, William Hirzy is now the paid lobbyist for Connett’s antifluoridationist group, FAN.

Cedric, you never addressed the main point of my post being that Brunelle and Carlos’ paper is misleading and erroneous and supported dental policy in the states and most likely elsewhere. When the hard data from the 1986-1987 National Survey of US School Children (39,000 participants) was scrutinized it was shown/proven that water fluoridation’s benefits are statistically insignificant. Now this data that was obtained through a Freedom of Information Act request and is available for anybody to scrutinize and see for themselves how water fluoridations benefits are grossly exagerated. If you want to try and distract from the issue by discrediting Dr Yiamouyiannis in the hopes of descrediting what I’m posting, it’s not going to work. I will bring everybodys attention back to the data that is freely available thanks to Dr. Yiamouyiannis. You don’t throw out the baby with the bathwater, Cedric. I could care less what Yiamouyiannis thought about HIV, abortion, religion, gay rights or who he associated. Just a cheap misdirection attempt by you. The fact that Brunelle and Carlos used relative difference to inflate the percentage of difference of dmfs between fluoridated and non-fluoridated participants screams red flag!!! Brunelle and Carlos deception and the hard data from the survey are what we should be concerned with. Nice try, Cedric.

Brunelle and Carlos can be quoted as averages to minimize the effect because the 0.6 surface is the effect averaged over both age and geography. 5 year olds have only 1 or two permanent teeth and there is essentially no difference between cavity rates at that early age yet they are counted in calculating the “average”.

By age 17 the difference between fluoridated and non-fluoridated is about 1.6 surfaces and the benefit curve is sharply accelerating with a benefit just under 3 times higher than the 0.6 so commonly quoted.

The original graph was published in:
Int J Occup Environ Health. 2005 Jul-Sep;11(3):322-6. Scientific evidence continues to support fluoridation of public water supplies. Pollick HF.

Also, in areas where fluoridation is common the Halo effect minimizes the differences between the two types of water systems. Thus the average results actually hide both the Halo Effect and the remarkable differences between communities where fluoridation is uncommon. In the Pacific Region then fluoridated at 19% about the same as Oregon today the difference was a whopping 61%.

Ever asked yourself why the paper that age hasn’t shifted the scientific community’s consensus on fluoridation?

(..checks the date…)

1990? Holy-krazy-monkey-on-a-stik! And you are still waving it about?
What is it with science deniers and their passion for yesteryear?
Myles, have you noticed that the year is 2013?
At what point do you acknowledge that a paper has failed to get anywhere and has decidedly withered on the vine?

The man is dead. His “work” is even deader. It’s is demised. It has ceased to be. It’s pushing up the daisies.
Move on with your life.

Putting Y’s HIV denial aside for a moment, the second thing that struck me about his biography was the movement from one angle of objection to fluoridation to another (new) as each is refuted.
It’s redolent of a priori bias, in fact it’s almost conclusive evidence.
Anything will do.

You see it with AGW deniers and other areas too. The list of PRATTS just keeps growing longer as there is always another fool coming along and being taken in by even the most ancient ones.

Yep, Richard, exactly the “Precautionary Principle” gambit. Throw out one unsubstantiated claim after another then claim the Precautionary Principle should apply until “further research” is done. If allowed, it would be a permanent cessation, as the call for “further research” will never end.

Dr. Slott has well described the real take aways from the Brunelle and Carlos paper.

Dr. Yiamouyiannis’s slight of hand ruse was to use the DMFT statistic rather than the tooth surface (DMFS) data. DMFT averaged over age and geography is not significantly different between fluoridated and not cities. Slott has well explained these issue.

Iida and Kumar’s recent analysis of the same Brunelle and Carlos data set showed fluorosis to prevent cavities. It was no surprise that in commenting on this new analysis all Professor Connett talked about was the DMFT data when he tried to poo-poo Kumar’s finding with the byline “Study Shows Fluoridation is Money Down the Drain.”

The pretense that DMFT data is THE important measurement of fluoridation’s benefit is behind much of the fluoridation opposition propaganda claiming ineffectiveness.

And of course the effect on adult teeth in school children is not fluoridation’s only benefit.

Fluoridation prevents about 2/3rds of the operations under general anesthesia preschool kids require for mouth fulls of rotten baby teeth. That effect saves about half of the dental bills for Medicaid children. This is found money to buy more health care for poor kids. If this were the only benefit the return on the fluoridation investment is 150%.

The overall return on investment from decreased dental bills is $38 or every dollar invested. That economic analysis assumed only that amalgam fillings or extractions were used and was based only on adult teeth cavities. It did not include the savings from avoiding baby teeth operations nor the effect on the cavities on the exposed root surfaces of older people. We are all looking forward to an updated study using more realistic reconstructive and prosthedontics costs.